SHM Converge Scientific Abstract ePoster Gallery-Tics From a Tick- A Case Report of Postencephalitic Parkinsonism

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This case describes a 77-year-old man with stage IV mantle cell lymphoma, multiple myeloma, and atrial fibrillation who presented with 5 days of worsening ataxia, generalized weakness, tremors, neck stiffness/pain, headache, photophobia, and confusion after a recent deer tick bite. He had been taking doxycycline. On exam, he had bilateral upper extremity tremor, cogwheel rigidity, and gait instability. Brain and cervical spine MRI were negative for acute structural disease. Lumbar puncture showed lymphocytic pleocytosis, elevated CSF protein, and normal glucose, while infectious, fungal, malignant, and paraneoplastic studies were negative.<br /><br />Neurology suspected aseptic meningitis/encephalitis followed by post-encephalitic parkinsonism, likely secondary to the recent tick-associated illness. Parkinsonism is characterized by bradykinesia, resting tremor, rigidity, and postural instability, and can result from infections, drugs, or toxins. Because no definitive test distinguishes primary Parkinson disease from secondary parkinsonism, diagnosis relies on clinical context and supporting studies.<br /><br />The patient was treated with carbidopa/levodopa, which led to symptomatic improvement, and he was discharged on this regimen.<br /><br />The report highlights that infections may trigger secondary parkinsonism and that post-encephalitic parkinsonism should be considered in patients who develop new movement disorder symptoms after meningoencephalitis, including tick-associated illness.

Asset Subtitle

Azfar A. Farooqi

Meta Tag

Author List Azfar A. Farooqi, Chen Rong Phang

Category Clinical Vignettes

Concept Parkinsonism

Concept Parkinsons Disease

Concept Post-Encephalitic Parkinsonism

Concept Infection

Concept Encephalitis

Distinguished Non-Finalist

Presenter Organization Tidalhealth Peninsula Regional Medical Center

Presenting Author Azfar A. Farooqi

Track Adult

Keywords

mantle cell lymphoma

multiple myeloma

atrial fibrillation

tick bite

aseptic meningitis

encephalitis

post-encephalitic parkinsonism

cogwheel rigidity

carbidopa levodopa

lymphocytic pleocytosis

Parkinsonism

Parkinsons Disease

Post-Encephalitic Parkinsonism

Infection

Encephalitis